Experts advocate for widespread HIV testing

Amanda Cuda

Published 8:34 pm, Wednesday, May 1, 2013

David Hill remembers when infection by the human immunodeficiency virus -- or HIV -- was considered a death sentence.

When the virus that causes AIDS first came into the public consciousness, people were typically "at death's door" by the time they knew what was wrong with them, and there were minimal treatment options for those infected, said Hill, director of global public health at Quinnipiac University's Frank H. Netter School of Medicine.

While HIV infection is still not curable, it is treatable with medication, and people with the virus are living longer and healthier lives -- if they know they are infected.

Now medical officials are pushing to make HIV testing as routine as cholesterol or blood pressure tests. This week, the U.S. Preventive Services Task force recommended that all people ages 15 to 65, including pregnant women, be screened for HIV. It's the latest group to join the call for expanded testing, following the Centers for Disease Control and Prevention and other organizations.

"We hope now that a number of groups have recommendations, and have very similar recommendation, that this will provide an impetus for primary care providers to offer screenings and for patients to have them," said Dr. Douglas K. Owens, a member of the task force and a professor of medicine at Stanford University.

About 1.2 million Americans live with HIV infection, including 10,585 in Connecticut. Roughly 20 to 25 percent don't know they have the virus, according to the task force, an independent group of national experts in prevention and study analysis.

Owens said testing could help doctors identify HIV at its earliest stages when it's most treatable. HIV affects specific cells in the immune system and, over time, can destroy enough of these cells that the body can't fight off infection or disease. That's when HIV can lead to acquired immune deficiency syndrome, or AIDS.

HIV is spread a few ways, including unprotected sex and intravenous drug use. In this country, the virus is most prevalent in men who have sex with men; they made up 63 percent of new HIV infections in 2010, according to the CDC. The Preventive Task Force recommendations also ask that anyone of any age who is at higher risk be tested.

He said most insurers cover HIV testing and, while that's good for consumers, it is an added cost to the health care system. Widespread testing might also put an extra burden on already-taxed health care workers.

"At a time when healthcare providers are asked to so much, this is another procedure to add to their workflow," Andresen said.

If HIV tests were more widespread, doctors would probably benefit from support staff to help counsel patients who might resist the idea, said Dr. Zane Saul, chief of infectious disease at Bridgeport Hospital.

"Asking a 60-year-old married woman to do an HIV test isn't the same thing as asking her to do a cholesterol test," he said.

But both agreed that there are more pros than cons to making these tests routine. Just like any other illness, Andresen said, "early detection is key with HIV." Unfortunately, he said, many of those who get tested are "late testers," meaning they are close to an AIDS diagnosis by the time the virus is detected.

"At that point, (HIV has) already been doing damage to the immune system and might have been passed on to other people unintentionally," Andresen said.

In Connecticut, doctors will provide tests upon request, and a variety of public health agencies and clinics provide tests and counseling for free, including the AIDS Project of Greater Danbury, Southwest Community Health Center in Bridgeport and Optimus Health Care, with locations in Bridgeport, Stratford and Stamford.

"The whole idea behind testing everybody is that it's easier to catch it early," Saul said. "You don't want to wait until someone gets really sick because then it's harder to treat."